CMS/EIP Fiscal Report Center: 10
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/17/2009 Page: 1
Agency Filter:EIP DEI DEIP
Eligibility Filter:Part C (excluding not eligible)
List order: No List
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 48 26.50 980.50 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 1997 3185.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 2111 3481.50 128815.50 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 3648 30958.0 1145211.50 36.99
TCON-TCON-TRANSITION CONFERENCE 701 703.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 3650 38354.0 1275007.50 33.24
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 133 224.00 16800.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 64 96.00 7200.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 78 121.00 9075.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 46 82.00 6150.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 136 253.00 14041.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 707 1209.00 90675.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 461 786.00 58912.50 74.95
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 442 683.00 51225.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 707 1256.50 69735.75 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 468 642.50 48150.00 74.94
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 2 2.00 97.00 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 1.00 48.50 48.50
Subtotal (Total Children Is Unduplicated) 1398 5356.00 372110.25 69.48
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 59 84.00 4200.00 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 1 0.50 25.00 50.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 52 79.00 3950.00 50.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 8 11.00 550.00 50.00
CONPP-CONPP-CONSULT, PT, PHONE 1 0.50 12.50 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 66 41.25 2062.50 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 1 0.25 6.25 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 207 2857.25 142862.50 50.00
OCCT-97530-OT SESSION BY LICENSED OT 8 41.00 2783.08 67.88
PHY-97110-PT SESSION BY LICENSED PT 2 2.00 135.76 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 9 21.00 1425.48 67.88
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 223 124753 62376.50 0.50
Subtotal (Total Children Is Unduplicated) 225 127891 220389.57 1.72
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Total 171600.75 1867507.32 10.88
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Number of Children (Unduplicated) With at Least One Service 3652
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Center 10
Flag Claims Units Chgs Paid
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R 5 1.75 64.75 0.00
U 0 0.00 0.00 0.00
B 20785 13625.00 531170.31 153.00
P 7083 5898.50 288916.65 290126.35
D 636 456.00 18903.75 18995.50
S 174 109.00 4385.72 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
34134 151508.00 1023973.64 0.00
Other 2 2.50 92.50 92.50
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Total 62819 171600.75 1867507.32 309367.35